Predictive factors of difficult implantation procedure in cardiac resynchronization therapy

• Published in: Europace (London, England) England), 2010-08, Vol.12 (8), p.1141-1148
• Main Authors: Bisch, Laurence, Da Costa, Antoine, Dauphinot, Virginie, Romeyer-Bouchard, Cécile, Khris, Lila, M'baye, Alassane, Isaaz, Karl
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Pacing, Artificial - methods; Electrodes, Implanted - adverse effects; Equipment Failure Analysis - methods; Equipment Failure Analysis - statistics & numerical data; Female; Follow-Up Studies; Heart Failure - diagnosis; Heart Failure - physiopathology; Heart Failure - therapy; Humans; Male; Middle Aged; Multivariate Analysis; Predictive Value of Tests; Prosthesis Implantation - adverse effects; Prosthesis Implantation - methods; Severity of Illness Index; Stroke Volume - physiology; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - physiopathology; Ventricular Dysfunction, Left - therapy
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/euq146

The usefulness of cardiac resynchronization therapy (CRT) in patients with congestive heart failure is offset by its long, user-dependent, and technical procedure. No studies have been published regarding factors related to CRT implantation procedure duration and X-ray exposure. Additionally, only a few studies have investigated the predictive factors of primary left ventricular (LV) lead implant failure. The aim of this prospective study was two-fold: (i) to evaluate the prevalence and predictive factors of prolonged CRT implantation procedure and (ii) to identify the predictive factors of primary LV lead implantation failure. Between November 2008 and September 2009, 128 consecutive patients underwent CRT implantation; of these, 22 patients (17.2%) were excluded because of CRT generator replacement. Population characteristics were a mean age of 69 +/- 10 years, 28.3% female, New York Heart Association class 3.2 +/- 0.3, LV ejection fraction (LVEF; 29 +/- 6%), and QRS width 146 +/- 23 ms. Cardiac resynchronization therapy implantation was attempted in 106 patients, and first LV lead implantation was obtained in 96 of 106 patients (90.5% primary success). Ten primary implantations failed (9.5%), due to unsuccessful LV lead implants. A second procedure was successfully attempted in six patients with a second more experienced operator (5.7%). Among the remaining four patients, one patient required a surgical epicardial LV lead implantation, and the implantation was not reattempted in the other three patients. The overall success rate of CRT system implantation was 96.2% (102 of 106 patients). Procedure parameters were as follows: LV threshold (1.4 +/- 0.9 V); LV wave amplitude (15 +/- 8 mV); LV impedance (874 +/- 215 ohm); median procedure time (skin to skin), 55 min (45-80); and median of procedure fluoroscopy time, 11 min (6.2-29). In 24 patients (22.6%), difficult procedures requiring >or=85 min of implantation duration occurred. By univariate analysis, predictive factors of difficult implantation were LV ejection fraction (25.6 +/- 6 vs. 30.2 +/- 8%; P = 0.02), LV end-diastolic diameter (72.4 +/- 11 vs. 66 +/- 11 mm; P = 0.01), LV end-systolic diameter (LVESD; 62 +/- 12 vs. 56 +/- 12 mm, P = 0.04), and the operator's experience (very experienced operator vs. less experienced operator, P = 0.006). By multivariate analysis, only primary LV lead implantation failure, LVESD, and operator's experience were independently associated with difficult procedures. I